I am one of the under 65 crowd that would ER today if I could enroll in medicare. There are thousands, if not millions, of us out there. Someone else could have this job if I didn't have to worry about healthcare. Even if it cost me $600-$700, still better than dying in this office while life passes me by.

Well. I'm with you but it lookslike they are going to drop. All because of Lieberman.

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Well. I'm with you but it lookslike they are going to drop. All because of Lieberman.

I didn't know one senator could kill it. I thought it took 41.

Anyway, getting away from the politics, the bottom line from a practical standpoint is that still almost no one is emphasizing cost containment, which is really at the root of much of the health care problem. People may be talking about how much it would cost to provide this today, and even if the costs were fully "paid for" and the adverse selection concerns were addressed, there's little talk about how to stop the endless double-digit cost increases into the future. IMO, that must be the first thing we address. Once we can find a reasonable way to control costs, then it will be a much easier sell to make coverage more universal and portable.

__________________

__________________"Hey, for every ten dollars, that's another hour that I have to be in the work place. That's an hour of my life. And my life is a very finite thing. I have only 'x' number of hours left before I'm dead. So how do I want to use these hours of my life? Do I want to use them just spending it on more crap and more stuff, or do I want to start getting a handle on it and using my life more intelligently?"-- Joe Dominguez (1938 - 1997)

Anyway, getting away from the politics, the bottom line from a practical standpoint is that still almost no one is emphasizing cost containment, which is really at the root of much of the health care problem.

That's certainly one of the biggest issues, and the one glossed over the most. And it is huge.

It seems to me that, conceptually, there are two fundamental ways to control costs:
-- A) From the supply side. Limit the procedures patients are allowed to have (effectively limiting the number of procedures), and limit what the insurers/government are allowed to pay for them (the unit price).
-- B) From the demand side. The customer decides which services to buy (which insurance policy to buy and which medical services to buy with his co-pay) and shops for a price.

Our present "system" uses neither of these processes very well. The govt (Medicare) has supply-side cost controls which leads to cost shifting to the private side of the system and leads to the normal resource scarcity that always results when goods or services are priced below demand. The private side has only rudimentary cost controls--there's no efficient market for individual health insurance, there's no way for patients to shop for services by price, and there are few incentives to do so.

All the other cost-saving things being discussed (electronic records, re-importation of pharmaceuticals, reduced overhead and admin, etc) will happen only within one of the two frameworks above.

The current "reform" proposals (House and Senate) concentrate on supply-side controls.

One newly surfaced possible amendment to the current Senate proposal takes a few baby steps toward recognizing the potential of demand-side controls. I can't find the link to the article (apologies!), but a democratic senator has proposed allowing nearly anyone to buy individual insurance from the "insurance exchanges" that would be set up (the present Senate bill only allows these purchases by individuals who work for small employers or who are otherwise not covered by employer-sponsored insurance). In addition, (IIRC) the amendment encourages high-deductible policies (by letting people pocket the money saved) and expands availability of HSAs. The devil is in the details, but this approach, to me, is much more attractive than putting limits on the supply of services. And, if we can cut or weaken the employer-->insurance link, that's even better.

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